Nurses share accounts of 9-11 aftermath

by Susan Trossman, RN

September 11, 2001, is no longer just a day gone by. It now takes its place alongside other infamous dates like December 7, 1941, and November 22, 1963. But the events of that day are too fresh to be history yet, particularly for the countless registered nurses who cared for casualties stemming from the terrorist attacks or who still are pitching in any way they can.

When talking about their efforts, many RNs suggest they were just doing what nurses always do -- helping those in need. Their stories evoke many feelings -- sadness, fear, faith in humankind, professional pride and even hope. Nurses made a difference on September 11 and they will continue to make a difference in the lives of the people they touch. Here are just a few of their stories.

A cloud of dust, a fireball

Elizabeth Ayello was stuck in traffic on the Long Island Expressway when she and nurse colleague, Sheila Giambanco, witnessed both attacks on the World Trade Center towers.

When she saw the first explosion, Ayello wasn't sure what had happened. Then she saw the second plane hit the second tower. She remembers being amazed that the building initially was still standing. She recalls a cloud of dust and a fireball.

"In my mind, I knew right away this was no accident," Ayello said. "It was a very clear day. No one could 'accidentally' not see these towers. If it was mechanical difficulty, the pilot could ditch the plane in the river."

From L to R: New York University nursing student Faith Fisher, nursing professor Elizabeth Ayello and student Junie Volcy with Sen. James Jeffords (I-VT) at an October press conference supporting the Nurse Reinvestment Act. Ayello and her students discussed the role of nurses at the WTC.

Her first reaction was to call her husband. He occasionally worked at a branch office at the WTC and was injured when a terrorist bomb exploded there in 1993. After learning he was at another office and was safe, she turned her attention toward getting to New York University as quickly as possible. A clinical associate professor, Ayello, PhD, RN, CS, CWOCN, was to meet her students for their first day of clinicals in med-surg, but she knew that she and other nurse faculty would be needed elsewhere.

"I remember thinking of the enormity of it all -- the numbers of people in the towers," the New York State Nurses Association member said. "I thought the hospitals would fill up quickly, so other facilities would be needed to treat people."

Initially, Ayello, other faculty and their students headed toward New York University Medical Center, where they helped organize blood donation efforts. Other critical care faculty went to the NYU's downtown hospital four blocks from the WTC and to St. Vincent's, another nearby hospital.

"Almost immediately, people started walking into the lobby of the hospital wanting to help," she said. "Soon there was a two-and-a-half-hour wait to give blood and there wasn't enough staff to draw blood."

Ayello then volunteered to help set up an emergency treatment center at Chelsea Piers, a large sports center where New Yorkers normally go to play basketball and ice skate. She asked if any students wanted to join her -- making clear that it was strictly voluntary. All 12 in her group said "yes."

"The students were happy to be able to contribute," Ayello said. "Everybody wanted to do something. We as nurses have the wonderful opportunity to be able to do something, and we instinctively know what needs to be done. My expertise is in wounds, so I felt I could be really helpful."

Hitching a ride on emergency vehicles, the group was cheered by people who were lining the streets as they made their way to Chelsea Piers. Once there, they began setting up triage and specially designated treatment centers. Other parts of the complex became makeshift operating rooms. All in preparation for what was to come.

Unfortunately, Ayello and her students did not see the number of survivors they were expecting. Instead, she estimates they treated about 200 people, most of whom were rescue workers who were combing the site. She and her students washed out irritated eyes, gave breathing treatments, performed EKGs and treated minor burns and injuries.

"The students at first felt like they would not be able to do all the procedures that would be needed, but they rose to the occasion," Ayello said. "It also was wonderful to see them thinking like nurses."

Ayello was also proud of her students for providing the emotional support the injured rescue workers so desperately needed because of the horrible things they saw. Students gave rescue workers their personal cell phones so they could contact their families. And they convinced many of the police officers, firefighters and EMTs that they needed to rest for a while -- even though they wanted to immediately get back to the site.

Ayello and her students stayed until the following morning, when it was clear that Chelsea Piers would no longer be used as a triage site.

Since September 11, Ayello has spent much of her time attending memorial services. Many of her husband's co-workers did not make it out of their 86th floor office. She also sees a different New York -- state troopers stationed at command centers around town, fliers of lost loved ones posted on the streets.

"But people, in general, are kinder and more concerned about each other," she said. A nurse for nearly 31 years, Ayello also sees a profession that will remain strong based on the caring and commitment of her nursing students.

"Many of the students thought they wanted to be nurses before this experience. Now, they told me they know they want to be nurses," she said.

Focusing on 'little triumphs'

Melissa Velazquez, RN, is a staff nurse on the burn intensive care unit at Washington Hospital Center in Washington, DC. She also is a full-time student and mother.

On the morning of September 11, Velazquez headed into her second class of the day -- at 9:30 a.m. -- "completely clueless" as to the tragic events that were unfolding.

At the beginning of class, her professor explained that the WTC had been attacked. When they couldn't get a classroom TV to work, the professor and students decided to continue the lecture as usual. But as more details poured in, classes were canceled and students began leaving en masse.

At first Velazquez did not want to focus on the horror of what was happening. But she said, "I knew something was really, really wrong. Then I openly wept like I never did before."

Her first concern was to make sure her daughter was safe. Velazquez picked her daughter up at school, checked on other family members, called work and made child care arrangements for the next few days. Although she was on a scheduled vacation until Sept. 20, she wanted to help with the many casualties she was sure would come.

When Velazquez arrived at work, her colleagues already had received six Pentagon victims. Velazquez admitted the seventh survivor that evening and an eighth arrived the following afternoon. Normally, unit staff care for a maximum of five "large" burn patients at any given time.

"The unit was beyond it's usual capacity," said the District of Columbia Nurses Association member.

Taking care of new admits -- especially those with extensive burns -- is incredibly labor intensive.

It takes three to four staff to transfer a burn patient into the "tank," a large whirlpool tub that is used to take away dead tissue. At the same time, nurses need to continuously monitor the patient's blood pressure and other vital signs, fluid volume losses and prepare dressings -- among other responsibilities. Debriding is done by hand.

In addition to taking care of the patients, Velazquez and other nurses spent much of their time making sure patients' families got what they needed, including providing them with emotional support and helping them get in touch with other hospital departments, such as social work and pastoral care.

Nurses on the burn unit have a history of being there for each other.

"We rely on humor and each other for support," she said. "We're a very tight bunch of people. We also try to focus on the little triumphs of our patients."

For example, she was thrilled when her primary patient -- a Navy lieutenant -- was finally able to open his badly swollen eyes and, days later, when he was able to walk to the tank for his dressing changes.

Still it was difficult when one of the patients passed away.

Melissa Velazquez testified to the role of nurses in the aftermath of the Pentagon attack at a September congressional hearing on the nursing shortage.

"But the beat goes on, and we need to be there for our other patients. For all our defeats, we have a million and one victories," Velazquez said.

On September 11, Velazquez worked a 12-hour shift and she subsequently worked additional shifts despite her planned time off. She also pointed out that she was not the only nurse who answered the call when health care workers were so vitally needed.

After nurses at her facility went on strike over working conditions in the fall 2000, many RNs decided not to return to their former jobs. But they did show up on September 11 to work side-by-side with their former co-workers to provide the care that was needed.

"Nurses will drop everything they are doing to go where they are needed," Velazquez said. "Altruism is at the core of nursing. It's who we are."

Since the events, Velazquez, like others, feels her life has changed. She has become more involved in the nursing profession. She provided testimony before Congress and spoke at a Department of Health and Human Services-sponsored press event on the need for more nurses.

"I try to value each day I have, especially with my daughter," she said. "I'm trying to be a better person, a better nurse."

An unbelievable show of support

Lifelong New Yorker Nancy Issing, RN, first heard of the attacks on the WTC when her brother called her home with the news. Her husband turned on the TV news and shortly thereafter, they both heard the impact of the second plane crashing into the tower. Although they lived four miles away -- they could smell the smoke and see the fires from their bedroom window.

"At the time, we didn't really know what was going on," said Issing, an ER nurse at St. Vincent's, the hospital which eventually would receive hundreds of people injured by the blasts.

Issing immediately got dressed and then called work. Even though it was her day off, she was determined to help. When she first arrived at work, the towers had not yet collapsed. But the smell of burning fuel and metal was in the air -- a smell that continues to this day.

Issing was designated to provide emergency care to the most critical patients.

"Working in the ER, I've seen some really gruesome things," the New York State Nurses Association member said. "But I never saw the volume of people who came into the ER that day. So many of the injuries I saw were so severe. Some patients had burns over 90 percent of their bodies.

"It was one patient after another after another. It was overwhelming."

By Tuesday evening, though, Issing recalls standing with co-workers by the ambulance bays outside the ER and thinking, "Where are the patients? Why aren't they coming in?"

"It seemed like we saw a lot of patients for about three hours," she said. "Then it started to slow down. Then it stopped."

Issing, however, still provides care to rescue workers who continue to sift through tons of debris.

When looking back on the events of September 11, she and her co-workers have found it difficult to piece together details.

"It's all very muddled in our minds," she said. But what's very clear to Issing is the strong positive response from nurses and other hospital workers.

"I was touched and amazed with the nurses who came to our ER from all over -- Connecticut, Long Island, New Jersey -- all just looking to help," she said. "And over the past few weeks we've received an unbelievable showing of support, concern and pride from other nurses. We've gotten bouquets of flowers, notes and e-mails -- even from ER nurses in Scotland and Australia."

She also has enormous respect for the staff at her facility.

"The nurses I work with, the ER techs, the housekeepers -- all did an outstanding job that day," Issing said. "They were so focused and willing to do anything. It says a lot about people, and their ability to work under pressure."

A 'sacred burial ground'

Marianne Roncoli, PhD, RN, is a clinical associate professor at New York University and a pediatric nurse practitioner at Bellevue Hospital.

Her plan on September 11 was to treat pediatric asthma patients in Brooklyn. But after tuning into the news that morning, Roncoli realized she needed to head to Bellevue, a major trauma center in direct line with "ground zero."

When she arrived there, the hospital had already set up a triage team to treat children in an outpatient clinic. But the pediatric staff there saw only one baby.

"A mother came in covered with dust from the debris. She was worried that her baby had smoke inhalation," said Roncoli, a New York State Nurses Association member. "The baby was fine, and we told the mother to stay for a while and rest."

But although Roncoli and the pediatric staff didn't see many casualties, they used their down- time wisely.

"We started talking about how children were going to react to the events," she said. On the spot, Roncoli, other nurse practitioners, physicians and child-life staff developed materials that could be used by parents to help them talk to their teens and younger children about the crisis, as well as identify symptoms of post-traumatic stress syndrome. The materials were almost immediately translated into five languages by the child-life staff to be distributed to the diverse population Bellevue serves.

On the night of September 13, Roncoli and other health care workers went to "ground zero" to offer their services. It was nighttime, and many huge spotlights lit the area.

"It was almost like going into the ruins of the Acropolis or the Parthenon," Roncoli said. "It was a sacred burial ground. All I could do for a while was just stand there and look at the massive devastation."

A police officer took Roncoli, another nurse practitioner and a physician to "ground zero" where Stuyvesant High School was transformed into a triage area.

"It was set up like a MASH unit," Roncoli said. "There were handwritten signs on IV poles telling people where to go for which health problems."

Roncoli was amazed by what she saw at the scene: There were more medications on hand than there were normally at Bellevue. People from throughout the city brought food -- including gourmet meals -- for the workers. There was coffee and water everywhere. And the Christian Scientists had even set up massage tables for rescue workers.

Like nurses and other health care workers at other triage locations, Roncoli washed out a lot of eyes and gave saline nebulizers to workers whose nasal passages had dried out. She only saw a couple of workers whose asthma had flared up.

At one point, Roncoli and a colleague made a run to area department stores to pick up a supply of socks, shirts and underwear for rescue workers.

"We told the store manager at Filene's Basement what we needed, and she cleared the shelves out for us to take to the crash site. She never asked us who we were," she said.

At 1 a.m., Roncoli decided to go home. There was no public transportation available -- police had prohibited cabs, cars or buses from entering the area and the subway that ran under the WTC had collapsed. She figured she had to walk the five miles to her home. It then started to rain. As she was walking down the deserted streets a man in army fatigues drove by and asked her where she was headed. He immediately gave her a lift.

Roncoli is still amazed by the many acts of kindness among strangers.

On Sept. 15, Roncoli decided to help with a research project aimed at assessing police officers' current health and future risk of having cardiac and respiratory problems. Besides performing EKGs and pulmonary function tests on the officers, she also used the time to lend them some emotional support.

"What I was noticing was these guys needed people to talk to," she said. "Some hadn't called home for several days.

"I talked with them about how to talk with their children and tried to assess how they were doing and how their families were doing," she said. "I also reviewed the signs and symptoms of PTSD and what to expect in one month, six months. I have a feeling we will be seeing a lot of people with problems over the next year."

Thinking back on nurses' -- as well as student nurses' -- contributions during the past few weeks, Roncoli said, "I think everybody did a great job. We covered all the bases. We looked where things weren't being done and we filled the gaps. That's the nursing thing to do."

Taking care of the 'whole person'

In her role as chief nurse at the American Red Cross, Nancy McKelvey, MSN, RN, is accustomed to dealing with crises. But the events of September 11 -- and other ongoing threats to public safety -- have left her little time to catch her breath and reflect on how her life has changed.

On that day, McKelvey was attending the ANA-sponsored Call to the Nursing Profession summit. The meeting was being held in Reston, VA, a community not far from the Pentagon. Concerned that roadblocks would prevent her from getting to Red Cross headquarters in Washington, DC, McKelvey immediately got on the phone with staff there to discuss the response of nursing and the organization as a whole.

She then turned to her nurse colleagues -- leaders of ANA and other professional nursing groups -- to ask them for their support in "mobilizing their troops."

"The support of nurse leaders was and continues to be very helpful here in Washington and around the country," McKelvey said. "At the Red Cross, we're accustomed to dealing with disasters. We have systems in place from mobilizing large numbers of people to planning logistics for feeding and sheltering thousands," she said. "We have responded to hurricanes, earthquakes, major airline accidents and the Oklahoma City bombing, where we learned a lot of lessons."

Because these multi-regional attacks were nothing like anything seen before in the U.S., the Red Cross had to re-think some of their traditional response mechanisms.

"For instance, one of the initial key priorities is how do you mobilize people without the benefit of air travel," said the Maryland Nurses Association member. Normally, the Red Cross relies on a human resource database that matches volunteers' training, qualifications and experience with the needs generated by the disaster.

"Usually we can use the list, and put people on airplanes so they can go where they are needed," she said. This time, ground transportation initially was the only alternative.

In addition, it became clear that there was a need for a large contingent of nurses with varied skills to go New York City, Arlington, VA, Pennsylvania and other locations affected by the terrorist attacks. Since Sept. 11, more than 700 nurses have worked with the Red Cross to meet the needs of victims, families and workers.

Among other services, nurses are making condolence calls to those who have lost loved ones, as well as hospital and home visits to others who were injured or ill. They provide comfort and encouragement at respite centers, and they accompanied families on buses to the memorial service. They continue to participate in a range of activities, from providing health counseling and first aid to disaster workers to overseeing food preparation at Red Cross kitchens.

Nurses also assess family needs and secure appropriate resources to meet those needs.

"Some of the families' or victims' needs may be related to their injuries or loss," McKelvey said. "On the other hand, their health needs may be integrally related to needing food on the table or help paying their mortgage."

Whatever their needs, McKelvey said that nurses always "will jump right in and do whatever is required."

"I'm very proud to be a member of a group that cares for the whole person," she continued. "Disasters require this perspective."

In addition to the nurses who are working close to the disaster sites, other nurse volunteers have been staffing a Red Cross hotline where they have been fielding health care questions, including those having to do with anthrax signs and symptoms. And of course, Red Cross nurses who work in blood services logged plenty of hours.

Since the attacks, the Red Cross continues to be flooded with calls from nurses across the country asking how they can help. Thousands of nurses already have expressed an interest in obtaining disaster preparedness training so they can be ready to volunteer in the event of future disasters.

Various nursing organizations, such as the National Student Nurses Association, are working with the Red Cross to arrange for disaster training to be provided at their national meetings. McKelvey also suggests that individual nurses can obtain training now.

"I'd like to ask nurses to contact their local chapters to see how they can help and obtain training so they can be available in the event of another disaster," she said.

Susan Trossman is the senior reporter for The American Nurse.

Want to help?

The most recent reports indicate that nine nurses lost their lives as a result of the attacks on September 11. They are honored on the Virtual Nurse Memorial (VNM), which memorializes nurses who have died in the line of nursing care. While some of these nurses did not die in the line of duty, they are being included on the memorial because of the overwhelming impact of the events of September 11 on us all. To read their stories, go to www.geocities.com/Heartland/Woods/6780, click on The Memorial Listings; then Next; and then the World Trade Center link

In addition to these nurses, there are many others who were directly impacted by the terrorist attacks. You can help them by making a contribution to Nurses House, a nonprofit organization designated by ANA, the American Nurses Foundation and the New York State Nurses Association, to accept donations to assist RNs directly affected by the events of September 11. Nurses eligible for relief include those working in the surrounding hospitals, as well as those whose spouses were injured or lost in the disaster. Tax deductible contributions to Nurses House can be made by sending a check payable to: Nurses Relief Fund, American Nurses Foundation, P.O. Box 96441, Washington, DC, 20090-6441.

If you are interested in becoming a Red Cross volunteer, go to www.redcross.org.